Substance-Related Disorders Overview

 

Criteria --
 
Substance Intoxication: a reversible syndrome in which behavioral and psychological changes occurring after ingestion of an intoxicating substance.
 
Substance abuse: patient is using a substance that is causing work, law, or social problems but the patient is not yet dependent on the substance.
 
Substance Dependence: patient shows signs of tolerance and withdrawal and may realize the substance is bad for him but that this may not be enough to help him stop usage.
 
Substance Withdrawal: distress or impairment resulting after stopping the use of a substance.
 
Substance-Induced Disorders: includes dementia, delirium, persisting amnesia, psychotic disorder, sexual dysfunction, anxiety, etc. caused by using an intoxicating substance.
 
Evaluating for Substance Abuse: Physicians must determine how much of the drug the patient is using, how frequently, and how the drug is affecting the patient’s life.
 
Physical Examination: different drugs may have varying effects on the patient’s body.
 
Laboratory Evaluation: Drugs may show up in the blood or urine and the use of drugs increases the risk for certain diseases.
 
 
Substance Related Disorders –
 
I.                    Alcohol, sedatives
II.                 Opioids
III.               Cocaine
IV.              Nicotine
V.                 Phencyclidine (PCP)
VI.              Amphetamine/Methamphetamine (Speed, Crystal, Crank)
 

 

Alcohol

Alcohol Widrawal

Alcohol widrawal is believed to be related to the depressant effect of alcohol.  After using EtOH for a long time and then not taking it suddenly, may result in CNS excitation.

-Symptoms:  start within 6-24 hours of not drinking.
mild:  irritable, complain of insomonia
severe:  fever, disorientation, seizures, hallucinations
most serious:  Delirium Tremens (DTs).  Begins within 72 hours of last drink.  15%-20% mortality rate.  patient may have visual or tactile hallucinations, gross tremor, autonomic instability (so have to measure vital signs frequently)

Treatment: 
-give tapering doses of benzodiazepines (Librium or Chlordiazepoxide, Diazepam or Lorazepam)
-give 100 mg Thiamine, 1 mg folic acid, and a multivitamin.
-give magnesium sulfate (for postwithdrawal seizures)